Persistent Salty Taste in Mouth: When to Consult Neurology or Gastroenterology?

Persistent salty taste in the mouth?

Hello: I have been taking medications for gastroenterology, psychiatry, and cardiology for a long time.
However, I have been experiencing a salty taste in my mouth for the past six months, and it persists throughout the day, even drinking water does not alleviate it.
I am a long-term smoker, with a habit of over 20 years, averaging a pack a day, sometimes even more.
For nearly two months, I have occasionally found it difficult to swallow food, especially if it is dry; I need to drink water to help it go down smoothly into the esophagus.
Recently, I have been experiencing chest pain (not heart-related), with a pain point that runs in a straight line from my throat to the center of my chest, radiating to my back.
Sometimes, I wake up from the pain while sleeping.
Should I consult a neurologist, or is it sufficient to see a gastroenterologist? Please help me, thank you!

Antony, 40~49 year old female. Ask Date: 2016/06/10

Dr. Hong Weibin reply Neurology

Your issue is quite complex.
There are many factors that can lead to taste abnormalities, including long-term use of certain medications, smoking, neurological disorders, and even brainstem tumors, all of which may cause a salty sensation in the mouth.
It is advisable to consult a neurologist for further evaluation.

Additionally, experiencing difficulty swallowing, especially with dry and hard food, while liquid foods are easier to swallow, may be due to reduced saliva secretion from the salivary glands.
Possible causes for decreased saliva production could include long-term smoking, side effects from certain medications, autoimmune diseases, or specific infections (such as HIV).
It is recommended that you ask your physician to reassess your chronic prescriptions and reduce unnecessary medications.
Lastly, if you have been experiencing frequent chest pain that radiates to your back and has even woken you up at night, it is important to be cautious, as there are many serious medical conditions associated with chest pain, some of which can be life-threatening.
Conditions such as aortic dissection, myocardial infarction, and esophageal rupture are examples.
It is advisable to seek evaluation from a cardiologist or a thoracic specialist promptly to rule out dangerous causes of your chest pain.

Reply Date: 2016/06/10

More Info

The persistent salty taste in your mouth, combined with your other symptoms, warrants a thorough evaluation by healthcare professionals. Given your history of long-term medication use from gastroenterology, psychiatry, and cardiology, as well as your significant smoking habit, there are several potential underlying causes that need to be considered.

Firstly, the sensation of a salty taste can be attributed to various factors, including medication side effects, dehydration, or changes in salivary gland function. Certain medications, especially those affecting the central nervous system or the gastrointestinal tract, can alter taste perception. Additionally, smoking can impact taste and smell, potentially leading to altered sensory experiences. Chronic smoking is known to cause damage to the mucosal lining of the mouth and throat, which can contribute to taste abnormalities.

Moreover, the difficulty swallowing and the chest pain you described are concerning symptoms that should not be overlooked. These could indicate esophageal issues, such as esophagitis or gastroesophageal reflux disease (GERD), which can also lead to a salty taste due to the backflow of stomach contents. The pain radiating from your throat to your chest and back could suggest a more serious condition that requires immediate attention, such as esophageal spasm or even cardiac-related issues, although you mentioned it is not heart-related pain.

Given these symptoms, it is advisable to consult a gastroenterologist first. They can perform diagnostic tests such as an endoscopy to evaluate the esophagus and stomach, assess for any inflammation, strictures, or other abnormalities, and determine if GERD or another gastrointestinal condition is present. They may also evaluate your salivary function and check for any signs of dehydration or other systemic issues that could be contributing to your symptoms.

In addition to gastroenterology, consulting a neurologist may also be beneficial, especially if you continue to experience taste abnormalities, persistent pain, or other neurological symptoms. Neurological conditions can sometimes manifest with sensory changes, including taste, and a neurologist can help rule out any central nervous system issues that may be contributing to your symptoms.

Furthermore, it is essential to address your smoking habit, as it can exacerbate many of the issues you are experiencing. Smoking cessation can lead to improvements in taste and overall oral health, and it may alleviate some of the gastrointestinal symptoms as well.

In summary, your persistent salty taste, difficulty swallowing, and chest pain are symptoms that should be evaluated by a gastroenterologist as a priority. Depending on the findings, a referral to a neurologist may also be warranted. It is crucial to seek medical attention promptly to address these symptoms and improve your quality of life. Remember to communicate all your symptoms clearly to your healthcare providers to ensure a comprehensive evaluation and appropriate management.

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